Healthcare Fragmentation and the Frequency of Radiology and Other Diagnostic Tests: A Cross-Sectional Study

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Background

Patients who visit multiple outpatient providers are at greater risk of having uncoordinated, fragmented care, which has been linked to high rates of hospitalization and emergency department visits as well as lower satisfaction with care. This Commonwealth Fund–supported study investigated whether fragmented care is also associated with an increased use of radiology and other diagnostic tests.

What the Study Found

Using claims data from five commercial insurers, researchers identified 126,801 adults who visited outpatient providers four or more times in 2010. To determine whether their care was fragmented, the study considered both the number of outpatient providers each patient visited over one year and the number of times the patient saw each provider.

The number of radiology and other diagnostic tests ordered was twice as high among patients with the most fragmented care compared to those with the least fragmented care. Patients with multiple chronic conditions were affected the most. Among patients with five or more chronic diseases, those with the most fragmented care had 542 tests per 100 patients and those with the least fragmented care had 258 tests per 100 patients.

Conclusions

These findings raise concerns about patients’ exposure to unnecessary radiation, assuming that some of the testing was unnecessary or duplicative. In addition, the increased use of radiology entails substantial cost, given that a single MRI can range from $600 to $5,000.